NPIMap

Organization Active NPI

Bushman Psychological Services LLC

  • Mental Health Counselor
  • Burnsville, MN
National Provider Identifier
1861580607
Registry record updated Apr 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LP3946 Issued in MN
Legal business name
BUSHMAN PSYCHOLOGICAL SERVICES LLC
Practice address
14551 Judicial Rd Ste 100
Burnsville, MN 55306-4991
Phone
(952) 898-5020
Fax
(952) 898-5858
NPI assigned
Oct 10, 2006
Last updated
Apr 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Bushman, PHD. LPNPI 1982783221
Title
President
Phone
(952) 898-5020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X LP3946 MN Primary

Addresses

Primary practice location

14551 Judicial Rd Ste 100
Burnsville, MN 55306-4991

Mailing address

14551 Judicial Rd Ste 100
Burnsville, MN 55306-4991
Phone (952) 898-5020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031211000284 MN Part B Supplier - Clinic/Group Practice 8820994668 Receives reassigned benefits from 18 practitioners
Practice locations: Burnsville, MN

National Provider Directory

National Provider Directory

Locations

14551 Judicial Rd
Ste 100
Burnsville, MN 55306
Phone (952) 898-5020

14569 Grand Ave
Ste 200
Burnsville, MN 55306
Phone (952) 892-7690

1755 Southcross Dr W
Burnsville, MN 55306
Phone (952) 898-5020

2105 W 143rd St
Burnsville, MN 55306
Phone (952) 303-6832

Practitioners & affiliated clinicians

Practitioners 67

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 67

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522886400000",
    "number": "1861580607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14551 JUDICIAL RD STE 100",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553064991",
            "telephone_number": "952-898-5020",
            "fax_number": "952-898-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14551 JUDICIAL RD STE 100",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553064991",
            "telephone_number": "952-898-5020",
            "fax_number": "952-898-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUSHMAN PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2018-04-05",
        "status": "A",
        "authorized_official_last_name": "BUSHMAN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-898-5020",
        "authorized_official_credential": "PHD. LP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "LP3946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.